Tag: pubmed

Innov Surg Sci. 2024 Aug 26;10(3):109-119. doi: 10.1515/iss-2024-0014. eCollection 2025 Sep.

ABSTRACT

OBJECTIVES: After pancreatoduodenectomy (PD) due to pancreatic cancer, recurrence is frequent in almost half of the patients. The rate of R0 resections is associated with the probability of local recurrence and overall survival. A potential intervention to improve the rate of R0 resections is a more radical resection along the superior mesenteric artery (SMA); however, randomized data of such an approach are lacking. Therefore, we conducted the randomized, controlled PancER trial to evaluate the effect of an extended PD compared with conventional PD.

METHODS: Patients were randomized to either an extended PD consisting of a modified Kocher maneuver with partial resection of the prerenal fascia, an uncinate process first approach with systematic mesopancreatic dissection along the SMA equivalent to level III dissection according to Inoue, or conventional PD. The primary endpoint, rate of R0 resections, and other perioperative outcomes were compared.

RESULTS: A total of 50 patients were randomly assigned to extended PD (n=24) or conventional PD (n=26). R0 resections were 10 % more frequent in the extended PD group than in the conventional group (75.0 vs. 64.7 %), which was not statistically significant (p=0.59). Patients self-reported more diarrhea symptoms following extended PD after 30 days (p<0.01). Other perioperative outcomes as well as long-term outcomes were comparable between the two groups.

CONCLUSION: The PancER trial shows that extended PD with more radical resection along the SMA can be performed with comparable perioperative outcomes to conventional PD. Although the intervention improved the R0 resection rate by 10 %, this increase was below expectation. Therefore, an even more radical PD resection technique involving not only the SMA but also the celiac and hepatic artery (TRIANGLE operation) was developed at Heidelberg University. The TRIANGLE operation is currently being evaluated in a randomized controlled multicenter trial. The results of the PancER trial served as pilot data for this subsequent study.

PMID:41143201 | PMC:PMC12552034 | DOI:10.1515/iss-2024-0014

Front Cardiovasc Med. 2025 Oct 10;12:1653988. doi: 10.3389/fcvm.2025.1653988. eCollection 2025.

ABSTRACT

BACKGROUND: Isolated superior mesenteric artery dissection (ISMAD) is a rare arterial disease, and its exact cause is still not well understood. This study aimed to investigate the potential role of anatomical factors in the development of ISMAD.

METHODS: This case-control study included patients diagnosed with ISMAD via computed tomography angiography from two major medical centers in China. An equal number of age-sex and body mass index matched patients without aortic and superior mesenteric artery disease were selected as controls. Several anatomical parameters were compared between the ISMAD group and the control group. Significant parameters were identified through univariate and multivariate analyses, and models were evaluated using receiver operating characteristic (ROC) curve analysis. A p-value < 0.05 was considered statistically significant.

RESULTS: A total of 60 patients with isolated superior mesenteric artery dissection and 60 age-sex (52.6 ± 6.1 vs. 52.2 ± 13.5, p = 0.82) and body mass index (24.3 ± 2.5 vs. 24.0 ± 4.0, p = 0.72) matched normal controls from two major hospitals in China were included in the study. Compared with normal controls, the multivariate analysis revealed that curvature (OR 1.239, 95% CI 1.122-1.369, p < 0.001) and tortuosity (OR 0.002, 95% CI, 0.000-0.083, p = 0.001) were independent predictors of ISMAD occurrence.

CONCLUSION: Patients with ISMAD exhibited higher levels of curvature and lower levels of tortuosity compared to normal control group.

PMID:41143194 | PMC:PMC12549576 | DOI:10.3389/fcvm.2025.1653988

Echocardiography. 2025 Nov;42(11):e70329. doi: 10.1111/echo.70329.

ABSTRACT

BACKGROUND: Essential hypertension is associated with structural and functional cardiac changes, including left ventricular hypertrophy (LVH), which significantly increases cardiovascular risk. Left anterior fascicular block (LAFB), historically considered benign, has recently been linked to adverse outcomes. Carotid intima-media thickness (CIMT) is a noninvasive marker of subclinical atherosclerosis. The interplay between LAFB, LVH, and CIMT in hypertensive patients remains poorly defined.

METHODS: We conducted a cross-sectional study of 256 patients with essential hypertension, divided into LAFB (n = 60) and non-LAFB (n = 196) groups. All participants underwent 12-lead electrocardiography, echocardiography, and carotid ultrasonography. CIMT was measured as a surrogate of vascular remodeling. Echocardiographic indices of cardiac remodeling and CIMT were compared between groups. Logistic regression identified independent predictors of LAFB.

RESULTS: Patients with LAFB had significantly higher left atrial diameter (LAD), left atrial volume index (LAVI), interventricular septal thickness (IVST), posterior wall thickness (PWT), left ventricular mass (LVM), left ventricular mass index (LVMI), and prevalence of LVH compared with those without LAFB (all p < 0.001). Mean CIMT values were also greater in the LAFB group (0.82 ± 0.27 vs. 0.72 ± 0.19 mm, p = 0.003). ROC analysis identified LAD >35 mm and LVMI >81 g/m² as useful predictors of LAFB. Multivariate logistic regression showed increased LAD (OR = 7.94, 95% CI: 2.24-28.10, p = 0.001) and LVM (OR = 3.37, 95% CI: 1.49-7.57, p = 0.003) as independent predictors of LAFB.

CONCLUSION: In essential hypertension, LAFB is associated with more advanced cardiac remodeling and increased CIMT. LAD and LVM were independent predictors of LAFB, suggesting that this ECG finding may serve as a simple marker of higher cardiovascular risk.

PMID:41139238 | DOI:10.1111/echo.70329

Int Forum Allergy Rhinol. 2025 Oct 26. doi: 10.1002/alr.70058. Online ahead of print.

ABSTRACT

BACKGROUND: Botulinum toxin type A is a potent neurotoxin and was first approved for use in 1989; since there has been a surge in its uses. The latest international trend is the unapproved use of botulinum toxin for allergic and nonallergic rhinitis, being advertised as “Haytox.”

METHODS: A single-group open-label non-randomized Phase 1 clinical trial was completed. Rhinitis and nonallergic rhinitis were confirmed via formalized examination and testing with total IgE and radioallergosorbent test (RAST). Participants received 40 units of botulinum toxin type A, administered topically intranasally, 20 units per nostril, using the LMA MAD Nasal Intranasal Mucosal Atomization Device. Safety of the intervention was assessed with adverse event tracking logs. Symptom scores were used to assess symptom reduction, including total nasal symptom score (TNSS), visual analog scale (VAS) measurements at Weeks 0, 2, 4, and 12. In addition, peak nasal inspiratory flow (PNIF) was measured at Weeks 0 and 4, with the minimum clinically important difference (MCID) being used to demonstrate any clinically significant change in the TNSS score.

RESULTS: A TOTAL OF: 15 participants enrolled, of which 14 participants received treatment, with no serious adverse or related adverse events reported. There was a statistically and clinically significant reduction in TNSS and a statistically significant reduction in VAS from Weeks 0 to 12.

CONCLUSION: In this Phase 1 trial, topical application of botulinum toxin via spray was shown to be safe, without any significant adverse events. It reduced the TNSS and VAS across the cohort. However, the treatment efficacy should be taken in context as there was no blinding, alternative dosing, or comparison against placebo or recognized active treatment options. This safety data should embolden future research trials.

TRIAL REGISTRATION: TGA number: CT-2024-CTN-02905-1; ANZCTR number: ACTRN12624000772549.

PMID:41139237 | DOI:10.1002/alr.70058

Clin Transplant. 2025 Nov;39(11):e70359. doi: 10.1111/ctr.70359.

ABSTRACT

Our study includes 103 patients aged between 51 and 60 years who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) from matched sibling donors (MSDs) (n = 36), haploidentical donors (HIDs) (n = 56), and unrelated donors (URDs) (n = 11). Multivariate analysis exploring the relationship between risk factors and survival confirmed that survival outcomes were only independently impacted by Eastern Cooperative Oncology Group (ECOG) score (ECOG scores ≥2 vs. ECOG scores of 0-1, overall survival [OS] HR: 2.91 [95% CI 1.35-6.27], p = 0.006; failure free survival [FFS] HR: 2.93 [95% CI 1.33-5.88], p = 0.006; graft-versus-host disease-free/relapse-free survival [GRFS] HR: 2.80 [95% CI 1.33-5.88], p = 0.006), while age, specific donor source and hematopoietic cell transplantation-comorbidity index (HCT-CI) score did not significantly influence prognosis in this age group. After applying propensity score-matching (PSM) to balance the pretransplant clinical factors between patients with ECOG scores 0-1 cohort and those with ECOG scores ≥2 cohort, poor performance status remains a negative factor for survival outcomes (OS p = 0.04; FFS p = 0.03; GRFS p = 0.03). Further analysis in subgroup patients with HCT-CI scores 0-1 found the retained significance of ECOG score in predicting inferior survival. In conclusion, our results indicate good long-term results of allo-HSCT in elderly SAA adults regardless of donor type. Higher ECOG score is associated with poor post-transplant outcomes and has to be taken into account for patients, even at a low-risk comorbidly burden.

PMID:41139235 | DOI:10.1111/ctr.70359

Int J Neurosci. 2025 Oct 26:1-14. doi: 10.1080/00207454.2025.2580332. Online ahead of print.

ABSTRACT

Objective This study employs the Mendelian randomization (MR) approach to investigate the causal relationships among immune cells, cluster headache (CH), and potential mediation by serum metabolites. Methods Using genome-wide association study (GWAS) data, MR analyses were conducted on 731 immune cell phenotypes, 1400 serum metabolites, and CH. The inverse variance weighting (IVW) method was employed as the primary analytical approach, supplemented by MR-Egger and weighted median analyses. Stability of results was assessed using Cochran’s Q and other statistical tests. Results The analysis identified a negative causal relationship between CD39⁺ CD4⁺ %T cells and CH, supported by sensitivity analyses. Reverse MR analysis showed no effect of CH on CD39⁺ CD4⁺ T cells, suggesting a unidirectional role of these cells in reducing CH risk. Further mediation MR analysis indicated that CD39⁺ CD4⁺ T cells may influence CH risk through the regulation of either the adenosine 5′-diphosphate (ADP) to N-acetylneuraminate ratio or the choline phosphate to phosphoethanolamine ratio, with mediation effect ratios of 12.4% and 12.5%, respectively. Conclusion CD39⁺ CD4⁺ T cells may reduce CH risk by increasing the adenosine 5′-diphosphate (ADP) to N-acetylneuraminate ratio or the choline phosphate to phosphoethanolamine ratio. These findings provide novel insights into potential targets for the prevention and treatment of CH.

PMID:41139232 | DOI:10.1080/00207454.2025.2580332

Cancer. 2025 Nov 1;131(21):e70140. doi: 10.1002/cncr.70140.

ABSTRACT

BACKGROUND: In acute myeloid leukemia (AML), measurable residual disease (MRD) assessment is essential for predicting relapse and guiding therapy decision-making. Nucleophosmin 1 (NPM1) mutations are reliable MRD markers but apply to only ∼30% of patients with AML. Wilms tumor 1 (WT1) expression monitoring is applicable to a broader population but the European LeukemiaNet (ELN) threshold of 50 WT1 copies per 10⁴ ABL copies (0.5%) may be too high, which limits sensitivity.

METHODS: With WT1 expression data from 100 healthy controls, this study established a revised WT1 threshold of seven copies per 10⁴ ABL copies (0.07%). Its performance was retrospectively validated against NPM1 in 308 paired follow-up samples from 63 patients with NPM1-mutated AML, and against the core binding factor (CBF) β-MYH11 fusion transcripts in 83 samples from 12 patients. Statistical analyses included concordance, sensitivity/specificity, survival estimates, and model comparison with the Akaike information criterion.

RESULTS: Compared to the ELN cutoff, the revised threshold showed higher concordance with NPM1 (78.6% vs. 73%) and sensitivity (54% vs. 24%; p < .0001) and acceptable specificity (91% vs. 98%; p = .002). In survival analyses, the seven-copy cutoff demonstrated stronger prognostic value than the ELN threshold, particularly after consolidation therapy. In the CBFB::MYH11 cohort, the two thresholds showed similar concordance but WT1 positivity with the revised cutoff preceded relapse in selected patients.

CONCLUSIONS: In AML, the revised WT1 threshold of seven copies per 10⁴ ABL copies enhanced MRD sensitivity while maintaining specificity, improving concordance with NPM1, and showing prognostic relevance. These findings support the clinical value of locally optimized WT1 thresholds, and highlight the need for prospective multicenter validation and harmonization of WT1-based MRD monitoring.

PMID:41139231 | DOI:10.1002/cncr.70140

Cancer. 2025 Nov 1;131(21):e70133. doi: 10.1002/cncr.70133.

ABSTRACT

BACKGROUND: The high costs of cancer care may lead to medical debt for patients and families. This study examined the association of county-level medical debt and timely treatment initiation among individuals newly diagnosed with cancer.

METHODS: Individuals aged 19 years and older who were newly diagnosed with acute leukemias, diffuse large B-cell lymphoma, Hodgkin lymphoma, female breast cancer, colorectal cancer, and lung cancer with consecutive enrollment in the same insurance type from the month of diagnosis through 90 days afterward were identified from the 2012-2021 Colorado Central Cancer Registry linked to the Colorado All-Payer Claims Database with information about county-level medical debt from the Urban Institute (N = 35,789). The exposure was the county-level share of adults with medical debt in collections, categorized in four quartiles (Q1-Q4). The outcome was timely treatment initiation-defined as the receipt of any cancer-directed treatment within 90 days after cancer diagnosis. The association of county-level medical debt and time to treatment initiation was examined by using multivariable Cox models.

RESULTS: Higher county-level medical debt was associated with lower likelihood of timely treatment initiation for all selected cancers combined (Q4 [counties with the highest medical debt rate; n = 8652] vs. Q1 [counties with the lowest medical debt rate; n = 9042]: hazard ratio [HR], 0.916; 95% confidence interval [CI], 0.871-0.963; p for trend = .001), for female breast cancer (Q4 vs. Q1: HR, 0.910; 95% CI, 0.847-0.978; p for trend = .011), and among individuals aged 19-64 years with private health maintenance organization plans (Q4 vs. Q1: HR, 0.790; 95% CI, 0.699-0.893; p for trend = .002) or Medicaid coverage (Q4 vs. Q1: HR, 0.869; 95% CI, 0.786-0.960; p for trend = .013).

CONCLUSIONS: Policies aimed at preventing and alleviating medical debt could be effective strategies for improving access to timely treatment.

PMID:41139228 | DOI:10.1002/cncr.70133

Med Sci Monit. 2025 Oct 26;31:e950416. doi: 10.12659/MSM.950416.

ABSTRACT

BACKGROUND Foot biomechanics significantly influence weightlifting performance and injury prevention. Previous studies have indicated that intensive weightlifting impacts foot structure; however, comprehensive investigations into foot characteristics among weightlifters remain scarce. This study aims to compare the foot arch index (FAI), plantar load distribution (PLD), center of pressure (CoP), and rearfoot posture in 24 elite male weightlifters (77 kg and 85 kg classes) and 32 age- and body mass index-matched healthy men. MATERIAL AND METHODS A cross-sectional study was conducted involving 24 elite male weightlifters and 32 healthy controls. The JC Mat optical plantar pressure analyzer was used to assess FAI, PLD, and CoP during static stances, while rearfoot angles were measured through postural alignment analysis. Statistical comparisons were performed using independent samples t test or the Mann-Whitney U test. RESULTS Weightlifters exhibited significantly higher FAI values (P<0.05) and greater rearfoot valgus angles (P<0.01) for both feet, compared with the controls. Their PLD was predominantly concentrated at the medial longitudinal arches (P<0.05), medial heels (P<0.01), and lateral metatarsals (P<0.05), as well as the left medial metatarsals (P<0.05). CoP distribution was symmetrical across both feet. CONCLUSIONS Elite weightlifters in this study developed low-arched pronated foot postures, characterized by medial-dominant PLD patterns and bilateral symmetrical CoP. These biomechanical adaptations may enhance stability and balance during weightlifting, whereas increased rearfoot valgus may predispose athletes to lower limb injuries. Systematic assessment of foot biomechanics is essential for optimizing performance, preventing injuries, and designing weightlifting-specific footwear.

PMID:41139217 | DOI:10.12659/MSM.950416

BMC Cancer. 2025 Oct 25;25(1):1645. doi: 10.1186/s12885-025-14809-2.

ABSTRACT

BACKGROUND: Prostate cancer is the most prevalent cancer among men within the U.S. and globally, with rising incidence, including advanced-staged disease. Risk factors for aggressive prostate cancer are not well defined. This systematic review and meta-analysis provide an overview of the relationship between cardiometabolic diseases (diabetes, dyslipidemia, obesity, and hypertension) and aggressive prostate cancer.

METHODS: Aggressive prostate cancer was defined as disease that has spread or is at high risk of spreading: high-risk or very high-risk localized (T3-T4, Grade Group 4-5), node-positive (N1), or metastatic (M1). Using PRISMA guidelines, a total of 4,830 publications revealed 25 cohort studies of over 974,000 men. Following the systematic review of these prospective studies of men with prostate cancer, R was utilized to run a random effects model, yielding hazard ratios with 95% confidence intervals and generating forest plots with measures of heterogeneity.

RESULTS: Examination of these studies revealed that a positive association exists. Diabetes was associated with a significantly increased risk of aggressive prostate cancer (HR = 1.18; 95% CI: 1.07-1.30; p = 0.0008). Obesity also showed a significant association (HR = 1.15; 95% CI: 1.06-1.24; p = 0.0006), as did hypertension, though to a lesser degree (HR = 1.07; 95% CI: 1.00-1.14; p = 0.04). Dyslipidemia was not significantly associated with aggressive prostate cancer (HR = 1.03; 95% CI: 0.98-1.03; p = 0.26).

DISCUSSION: Three of the four cardiometabolic disease components (diabetes, obesity and hypertension) were shown to have statistical significance and offered intriguing evidence on their potential associations with aggressive prostate cancer. Dyslipidemia’s association was not statistically significant, which could be attributed to variations in methods of assessment and differing mechanistic effects. High heterogeneity and limited study availability remain key limitations.

CONCLUSION: If such associations between cardiometabolic diseases and prostate cancer aggressiveness are shown to be cause and effect, such controllable and treatable conditions can allow oncologists to work alongside primary care physicians to improve patient outcomes and reduce the incidence of aggressive disease. Through the promotion of lifestyle modifications, tighter cardiometabolic control, and targeted interventions, public health efforts might improve prostate cancer outcomes.

PMID:41139205 | DOI:10.1186/s12885-025-14809-2